Reframing Recovery: Fantasy Sports Metrics as Scalable Tools for Measuring Post-injury Athletic Performance

While return to play has traditionally been the benchmark for evaluating athlete recovery after injury, it does not adequately capture whether athletes regain their prior level of performance. The concept of return to pre-injury performance (RPIP) offers a more meaningful measure but lacks a standardized approach for quantification across sports. This narrative review examined the literature using fantasy sports scores and wins above replacement (WAR) to evaluate post-injury performance among professional athletes and to assess their utility as foundations for RPIP. A targeted PubMed search identified studies that used fantasy scores or WAR to quantify post-injury performance in the National Football League (NFL), National Basketball Association (NBA), National Hockey League (NHL), and Major League Basketball (MLB), requiring stratification by injury and use of publicly available scoring systems. Six studies encompassing 15 sport-specific cohorts and 785 athletes met the inclusion criteria. Fantasy metrics and WAR consistently reflected post-injury performance declines in 14 of 15 cohorts across different sports and injury types, despite variation in study design, scoring systems, and follow-up windows. However, only two studies explicitly referenced RPIP. Fantasy scores and WAR may serve as scalable tools for quantifying post-injury performance and provide a preliminary framework for standardizing RPIP across sports. Their public availability, longitudinal structure, and comprehensiveness make them uniquely suited for research, clinical, and operational use. Formalizing RPIP around these metrics could significantly enhance recovery evaluation and decision-making in sports medicine.